What is the clinical evidence from this study?

Study design: Case-Control. Population: Hand, foot and mouth disease (n=882). Intervention: Exclusive breastfeeding vs. Mixed feeding. Primary outcome: Occurrence of hand, foot and mouth disease (OR 0.63, 95% CI 0.47-0.85, p=0.002).

What does this research mean for the field?

Exclusive breastfeeding during the first 6 months reduces the odds of hand, foot and mouth disease by 37% compared to mixed feeding in children under 4 years of age, with the protective effect persisting up to 28 months. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

December 1, 2014Open Access

Protective effect of exclusive breastfeeding against hand, foot and mouth disease

Key Result

Exclusive breastfeeding during the first 6 months reduced the odds of hand, foot and mouth disease by 37% (OR 0.63) compared to mixed feeding in children under 4 years of age.

Study Design

Type

Case-Control (n=882)

Multicenter

Yes

Structured PICO

Does exclusive breastfeeding prevent hand, foot and mouth disease in children aged 4 years or younger?

Population

882 children aged 4 years or younger in Guangdong Province, China, including 316 newly diagnosed cases of hand, foot and mouth disease (HFMD) and 566 healthy controls.

Intervention

Exclusive breastfeeding during the first 6 months of life

Comparator

Mixed feeding type (breast feeding and supplementary fluids)

Outcome

Occurrence of hand, foot and mouth disease (HFMD)

Exclusive breastfeeding during the first 6 months of life is associated with a reduced risk of hand, foot and mouth disease in children up to 28 months of age.

Main Result

Effect estimate: OR 0.63 (95% CI 0.47-0.85)

p-value: p=0.002

Limitations

Potential selection bias from recruiting subjects from 6 specific cities
Lack of data on the exact duration of breastfeeding in months
Potential recall bias from parental reporting of breastfeeding type
Most cases were diagnosed based on clinical symptoms rather than virological testing

Abstract

BACKGROUND: Infants who are exclusively breastfed receive natural protection against some infectious agents. This study examined whether there was protective effect of exclusive breastfeeding on the occurrence of hand, foot and mouth disease, which was an emerging infectious disease among children in China. METHODS: A community-based case-control study was carried out among children age 4 years or younger in Guangdong Province, China. Cases were newly diagnosed hand, foot and mouth disease. Controls were randomly sampled from healthy children from the nearby village. Unconditional logistic regression model was used to estimate the odds ratio (OR) for exclusive breastfeeding after adjusting for potential confounding factors. RESULTS: A total of 316 cases and 566 controls were included in the analysis. Significantly beneficial effect of exclusive breastfeeding during the first 6 months was observed for hand, foot and mouth disease occurrence. The overall OR was 0.63 (95% CI: 0.47-0.85) for exclusive breastfeeding compared with mixed feeding type. The age-specific analyses indicated that the protective effect persisted till the age of 28 months. CONCLUSIONS: This study suggests that exclusive breastfeeding might have protective effect against HFMD infection among the children within 28 months of age.

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